The impact of low back pain and disability on frailty levels in older women: longitudinal data from the BACE-Brazil cohort.

METHODS: This is a longitudinal observational study with a convenience subsample from the international Back Complaints in the Elders (BACE)-Brazil. Frailty was assessed by researchers at baseline, 6 and 12 months according to the Frailty Phenotype. Pain was assessed using a Numerical Pain Scale (NPS). Disability was assessed using the Roland Morris Disability Questionnaire. RESULTS: A total of 155 older women (70.4 ± 5.4 years) participated. Follow-up for 6 and 12 months in this study was associated with a change of older women to worse frailty levels (OR = 2.83, 95% CI 1.98-4.67; p < 0.01). A significant association was observed between greater pain intensity and the transition of the older women through the frailty levels (ß = - 0.73; p < 0.01) when inserting the pain variable at baseline of the statistical model. Older women who reported greater pain intensity worsened their frailty level. The same happened when the disability variable was inserted in the model (ß = - 0.74; p < 0.01). The criteria proposed by Fried et al. were able to identify frailty throughout the follow-up and no prevalence of any item. CONCLUSIONS: In older women, relevant factors such as pain and disability are closely linked to the frailty phenomenon. Thus, the frailty syndrome must be assessed, monitored and treated in relation to the individualities of older adults, as those with back pain and greater disabilities are more susceptible to frailty.

Inflammatory mediators and the risk of falls among older women with acute low back pain: data from Back Complaints in the Elders (BACE)-Brazil.

PURPOSE: To investigate the association between plasma levels of inflammatory cytokines (interleukin [IL]-1-ß, IL-6, tumor necrosis factor [TNF]-α, and the soluble TNF receptor 1 [sTNF-R1]), disability, and risk of falls in older women with acute low back pain (LBP). METHODS: This cross-sectional study comprised a subsample of older women from the Back Complaints in the Elders international cohort study. Plasma levels of IL-1-ß, IL-6, TNF-α, and sTNF-R1 were measured using enzyme-linked immunosorbent assays. Pain was assessed using the Numerical Pain Scale and McGill Pain Questionnaire, while disability was measured using the Roland Morris Questionnaire and gait speed. Risk of falls was estimated using the Physiological Profile Assessment. Linear regression model was used to verify the association between independent variables and fall risk. RESULTS: One hundred and ten women (aged 69.97 ± 5.5 years) with acute LBP were included. The regression model showed an association between the risk of falls and IL-6 levels, pain, gait speed, and years of education. It also explained 21.2% of risk of falls variance. The model equation was: fall risk = 1.28 + (0.19 IL-6) + (0.02 quality of pain) + (- 0.71 gait speed) + (-0 .17 educational level). CONCLUSIONS: This study showed an association between risk of falls and IL-6, pain, gait speed, and educational level in older women with LBP. These slides can be retrieved under Electronic Supplementary Material.

Avaliação dos níveis de ansiedade, estresse e qualidade de vida em acadêmicos de Fisioterapia / Evaluation of the levels of anxiety, stress and quality of life in Physical Therapy students

Introdução: No âmbito acadêmico, os universitários, especialmente da área da saúde, estão expostos a diversas situações estressantes que podem afetar diretamente sua qualidade de vida. Objetivo: Caracterizar a qualidade de vida, ansiedade e estresse bem como a associação entre esses fatores em acadêmicos do curso de Fisioterapia da Universidade de Itaúna. Métodos: Foram convidados para o estudo todos os alunos matriculados no curso de fisioterapia da Universidade de Itaúna. Para avaliação foi utilizado um questionário sociodemográfico, o Medical Outcomes Study 36 (SF-36) e as escalas IDATE-traço, IDATE-estado e Escala de Percepção de Estresse ­ 10 (ESP-10). Resultados: Entre os 227 acadêmicos, a média de estresse foi de 23,53 (± 6,63), qualidade de vida no domínio físico 68,51 (± 18,29) e o mental, 55,17 ± 23,01. Os níveis de ansiedade variaram entre moderado e alto. Conclusão: Os graduandos de fisioterapia apresentam sintomas de estresse e ansiedade que podem influenciar diretamente na qualidade de vida. (AU)

Introduction: Academic students, especially in health care, are exposed to various stressful situations that can directly affect their quality of life. Objective: To characterize the quality of life, anxiety and stress as well as the association between these factors in the academic course of physical therapy at the University of Itaúna. Methods: All students enrolled in the course of physical therapy at the University of Itaúna were invited to the study. For evaluation we used a demographic questionnaire, the Medical Outcomes Study-Short Form 36 (SF-36) and the scales trait (STAI-T), state (STAI-S) and Perceived Stress Scale - PSS-10. Results: Among the 227 academics, the average stress was 23.53 ± 6.63 points, quality of life in the physical domain 68.51 ± 18.29 points and mental, 55.17 ± 23.01. Anxiety levels ranged between moderate and high. Conclusion: The physical therapy students present symptoms of stress and anxiety and these can influence directly on the quality of life. (AU)

Inflammatory Mediators and Pain in the First Year After Acute Episode of Low-Back Pain in Elderly Women: Longitudinal Data from Back Complaints in the Elders-Brazil.

OBJECTIVE: The aims of this study were to determine the course of plasma levels of inflammatory mediators (interleukin 6 [IL-6], tumor necrosis factor α [TNF-α], soluble TNF receptor 1 [sTNF-R1]) and the severity of low-back pain (LBP) over 6 to 12 months after an acute episode of LBP in elderly women and to establish an association between inflammatory mediators and LBP recovery. DESIGN: This was a longitudinal study of a subsample (155 elderly women with acute LBP, aged ≥65 years) of the international Back Complaints in the Elders cohort study. Plasma levels of IL-6, TNF-α, and sTNF-R1 were measured using enzyme-linked immunosorbent assays and pain severity using the numerical pain scale. RESULTS: There was a decrease in the severity of LBP (P = 0.033) and in the levels of IL-6 and TNF-α (P < 0.001) and an increase in sTNF-R1 (P < 0.001) in the first year after an acute episode of LBP. The probability of occurrence of pain relief at the 12-month follow-up was 2.22 times higher in elderly women who had low levels of IL-6 (<1.58 pg/mL) at baseline. CONCLUSIONS: Our findings showed a relationship between inflammation and LBP by establishing that low IL-6 plasma levels preceded outcome (LBP recovery), supporting the concept that proinflammatory cytokines promote pain.

Association Between the Plasma Levels of Mediators of Inflammation With Pain and Disability in the Elderly With Acute Low Back Pain: Data From the Back Complaints in the Elders (BACE)-Brazil Study.

STUDY DESIGN: Cross-sectional study with subsample of elderly women with acute low back pain (LBP), from Back Complaints in the Elders-Brazil (BACE-Brazil) OBJECTIVE: To investigate the association between plasma levels of mediators of inflammation (interleukin-1 beta (IL-1ß), IL-6, tumor necrosis factor alpha (TNF-α), and soluble TNF receptor 1 (sTNF-R1)) with pain and disability experienced by elderly women with acute LBP. SUMMARY OF BACKGROUND DATA: Among the elderly, LBP is a complaint of great importance and can lead to disability. Inflammatory cytokines are elevated in painful conditions, and may promote pain. METHODS: We included 155 community-dwelling elderly women (age ≥ 65 yr), who presented with a new (acute) episode of LBP. Enzyme-linked immunosorbent assays were used to measure TNF-α, sTNF-R1, IL-1ß, and IL-6. Disability was assessed using the Roland Morris Disability Questionnaire; pain was assessed using the McGill Pain Questionnaire. Linear regression models were fit with each pain and disability outcome as dependent variables: Present Pain Intensity; Qualities of pain; Severity of pain in the last week; LBP frequency and disability. RESULTS: Depressive symptoms and IL-6 were associated and explained 20.9% of "qualities of pain" variability. TNF-α, sTNFR1, education, body mass index, and depressive symptoms explained 8.4% of "Severity of pain in the past week" variability. TNF-α, education, BMI, depressive symptoms, present pain intensity, qualities of pain, and LBP frequency explained 48.6% of "disability." No associations between inflammatory cytokines and "present pain intensity" and "LBP frequency" were found. CONCLUSION: Our results demonstrate associations between inflammatory markers (TNF-α and sTNFR1) and pain severity, IL-6 was associated with the qualities of pain, and TNF-α was also associated with disability. These inflammatory mediators represent new markers to be considered in the assessment and treatment of elderly patients with LBP. LEVEL OF EVIDENCE: 5.

Psychometric properties of the Brazilian version of the Pain Catastrophizing Scale for acute low back pain.

Measurement instruments of pain catastrophizing for middle-aged and elderly individuals are needed to understand its impact on low back pain. The goals were to cross-culturally adapt the Pain Catastrophizing Scale, assess the construct validity through Rasch analysis, and verify reliability and convergent validity of pain catastrophizing with psychosocial factors. 131 individuals aged 55 years and older with acute low back pain were interviewed . The intra-rater reliability was Kp = 0.80 and interrater Kp = 0.75. The Rasch analysis found adequate reliability coefficients (0.95 for items and 0.90 for individuals ). The separation index for the elderly was 2.95 and 4.59 items. Of the 13 items, one did not fit the model, which was justified in the sample evaluated. The pain catastrophizing correlated with most psychosocial factors. The instrument proved to be clinically useful. Subsequent studies should carry out the same analysis in different populations.

Psychometric properties of the Brazilian version of the Pain Catastrophizing Scale for acute low back pain / Propriedades psicométricas da versão brasileira da Escala de Catastrofização da Dor para dor lombar aguda

Measurement instruments of pain catastrophizing for middle-aged and elderly individuals are needed to understand its impact on low back pain. The goals were to cross-culturally adapt the Pain Catastrophizing Scale, assess the construct validity through Rasch analysis, and verify reliability and convergent validity of pain catastrophizing with psychosocial factors. 131 individuals aged 55 years and older with acute low back pain were interviewed . The intra-rater reliability was Kp = 0.80 and interrater Kp = 0.75. The Rasch analysis found adequate reliability coefficients (0.95 for items and 0.90 for individuals ). The separation index for the elderly was 2.95 and 4.59 items. Of the 13 items, one did not fit the model, which was justified in the sample evaluated. The pain catastrophizing correlated with most psychosocial factors. The instrument proved to be clinically useful. Subsequent studies should carry out the same analysis in different populations.

Instrumentos de medida da catastrofização da dor para indivíduos de meia-idade e idosos são necessários para compreensão do impacto na dor lombar nessa população. Os objetivos foram adaptar transculturalmente a Escala de Catastrofização da Dor, avaliar a validade de construto pela análise Rasch, verificar a confiabilidade e a validade convergente da catastrofização da dor com fatores psicossociais. Participaram 131 indivíduos comunitários com 55 anos e mais com dor lombar aguda. A confiabilidade intra-examinadores foi de Kp = 0,80 e inter-examinadores Kp = 0,75. A análise Rasch, detectou adequados coeficientes de confiabilidade (0,95 para itens e 0,90 para indivíduos). O índice de separação dos idosos foi de 2,95 e dos itens 4,59. Dos 13 itens, um não se enquadrou no modelo, o que se justificou na amostra avaliada. A catastrofização da dor se correlacionou com a maioria dos fatores psicossociais. O instrumento mostrou-se clinicamente útil. Estudos subsequentes devem proceder às mesmas análises em diferentes populações.

Functional performance and plasma cytokine levels in elderly women with and without low back pain.

BACKGROUND AND OBJECTIVES: Low back pain (LBP) is a complaint of great importance among the elderly due to its significant impact on function. LBP could contribute to changes in the regulatory process of inflammatory mediators observed in elders. The aim of this study was to compare plasma levels of interleukin(IL)-6, soluble tumor necrosis factor receptor 1(sTNF-R1), and functionality among 3 groups of elderly women: GI, with LBP; GII, without LBP but reports of other pain; and GIII, without any reported pain. MATERIAL AND METHOD: This was an observational study of a subsample of the international Back Complaints in the Elders cohort study. IL-6 and sTNF-R1 were measured using the enzyme-linked immunosorbent assay. Functionality was assessed using the Timed Up and Go, gait speed and Roland Morris Disability Questionnaire; and pain, using the numerical pain scale. RESULTS: Two hundred and thirteen women aged 71.35 ± 4.76 years were included. GI presented the highest sTNF-R1 levels (p=0.016), worst TUG performance (p< 0.001) and slowest gait speed (p< 0.01) compared to GII and GIII, which were similar (p > 0.05). No difference was found between the IL-6 plasma levels in any of the groups. CONCLUSION: Elderly women with LBP had the highest sTNF-R1 plasma levels and the worst functional performance compared to elderly women with reports of other pain (not LBP) or no pain.

O papel da catastrofização da dor no prognóstico e tratamento de idosos com osteoartrite de joelho: uma revisão crítica da literatura / The role of pain catastrophizing in prognosis and treatment of elderly with knee osteoarthritis: a critical literature review

A artroplastia total de joelho, procedimento realizado em pacientes com osteoartrite severa, pode levar à melhora na dor, na função física e na qualidade de vida, porém alguns indivíduos apresentam resultados negativos após esse procedimento. A catastrofização da dor tem sido apontada como o preditor psicológico mais importante para os piores resultados após a cirurgia. Assim, o objetivo deste estudo foi realizar uma revisão da literatura acerca da influência da catastrofização da dor no prognóstico e tratamento de indivíduos idosos com osteoartrite de joelho. Foi realizada uma busca da literatura nas bases de dados Medline via PubMed, Embase, Cochrane, Scopus, Science Direct, MedCarib, SciELO, LILACS e Google Acadêmico, a partir do primeiro registro até junho de 2012. A busca resultou num total de 2.227 artigos e, após exclusão por título, resumo e leitura integral, foram selecionados seis estudos. Todos os artigos mostraram como característica comum de tratamento a realização da artroplastia total de joelho. Apesar da análise de outras variáveis como depressão, ansiedade, gravidade da dor, incapacidade, somente a catastrofização revelou ser a variável que contribui significativamente para os resultados da recuperação após a artroplastia, contribuindo para maior tempo de permanência no hospital, maior intensidade de dor e piora na funcionalidade. É necessário que medidas básicas para a identificação dos indivíduos que catastrofizam mais sejam aplicadas e, assim, intervenções psicossociais podem ser necessárias para promover uma recuperação mais positiva em indivíduos que apresentam perfil de risco psicossocial, diminuindo o tempo de hospitalização.

Total knee arthroplasty performed on patients with severe osteoarthritis can lead to improvement in pain, physical function and quality of life. However, some individuals have negative results after this procedure. Pain catastrophizing has been identified as the most important psychological predictor for worse outcomes after surgery. This study aimed to review the literature about the influence of pain catastrophizing on prognosis and treatment of elderly subjects with knee osteoarthritis. Literature search was performed in Medline via PubMed, Embase, Cochrane, Scopus, Science Direct, MedCarib, SciELO, LILACS and Google until June 2012. The search yielded a total of 2,227 articles, and after exclusion by title, abstract and full text, six studies were included. All items shown as a common feature of treatment as TKA surgery. Although the analysis of other variables such as depression, anxiety, pain severity and disability, catastrophizing was considered the only variable that significantly contributes to the results of the recovery after arthroplasty, contributing to longer hospital stays, more pain and deterioration in functionality. It is necessary to put basic measures into practice to identify individuals who are more catastrophizers and thus psychosocial interventions may be needed to promote a more positive recovery in individuals presenting a profile of psychosocial risk, reducing the length of hospitalization.

Perfi l de idosos do município de Itaúna/MGe infl uência da atividade física na dor crônicae na capacidade funcional / Profi le of elderly in Itaúna/MG and infl uence of physical activity on chronic pain and functional capacity

A atividade física constitui um meio que auxilia na prevenção etratamento de várias doenças. Os objetivos do estudo foram traçaro perfi l sociodemográfi co e clínico dos idosos comunitários praticantese não praticantes de atividade física e verifi car a infl uênciada atividade física na intensidade da dor crônica e na capacidadefuncional desses indivíduos. Foi realizado um estudo transversalcom 48 idosos portadores de dor crônica no município de Itaúna/MG, divididos em dois grupos: praticantes de atividade física (F) enão praticantes (NF). Os idosos foram submetidos ao Mini-Examedo Estado Mental, a um questionário sociodemográfi co e clínico,à Escala de Depressão Geriátrica Abreviada (GDS); à Escala VisualAnalógica de Dor, ao Questionário da Avaliação da Saúde (HAQ)e ao Teste de Desempenho Físico Modifi cado (TDFM). Os dadosobtidos confi rmaram que a prática de atividade física diminui asqueixas de dor crônica, melhorando a capacidade funcional do idosoe, possivelmente, a convivência social do indivíduo. Confi rmaramtambém a feminização da população idosa no Brasil, a grande prevalênciade sintomas depressivos e a complexidade da dor crônicaa qual interfere desfavoravelmente na qualidade de vida do idoso...

Physical activity helps in the prevention and treatment ofdiff erent diseases. Th e aim of this study was to identify the sociodemographicand clinical profi le of community-dwelling elderlyparticipants or not in a physical exercise program and to check theinfl uence of physical activity in chronic pain intensity and functionalcapacity in these individuals. We conducted a cross-sectional studywith 48 elderly patients with chronic pain in Itaúna/MG. Th eywere divided into two groups: those who have performed physicalactivity (F) and those that have not (NF). Both groups underwentthe Mental State Examination, a socio-demographic and clinicalquestionnaire, the Geriatric Depression Scale Short (GDS), theVisual Analogue Scale for Pain, the Health Assessment Questionnaire(HAQ) and the Modifi ed Physical Performance test (TDFM).Th e results showed that physical activity reduces the complaintsof chronic pain by improving functional capacity and probablythe social life of the elderly. In addition, the results also confi rm alarge number of elderly women in the Brazilian population, highprevalence of depressive symptoms and the complexity of chronicpain which interferes unfavorably in quality of life...